International

Renal Anaemia in the news

Extra blood pressure lowering cuts renal events in type 2 diabetics

• 23 February 2009
• Reuters Health

NEW YORK (Reuters Health) - Reducing blood pressure with the drug combination perindopril-indapamide reduces renal events in patients with type 2 diabetes, even when the initial blood pressure is < 120/70 mmHg, according to a report in the April issue of the Journal of the American Society of Nephrology.

Lead author Dr. Vlado Perkovic, from the University of Sydney, Australia, and colleagues note that current guidelines recommend that antihypertensive therapy aim for blood pressures of < 130/80 and 125/75 mmHg in subjects with diabetes and nephropathy, respectively. Whether aiming for even lower pressures might enhance renoprotection was unclear.

The ADVANCE (Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation) study featured 11,140 patients with type 2 diabetes who were randomized to receive perindopril-indapamide or placebo, regardless of their initial blood pressure.

Over an average follow-up period of 4.3 years, treatment with the drug combo cut renal events by 21%, the result of reduced rates of both micro- and macro-albuminuria (p < 0.003 for both), the investigators report. As noted, benefits were evident regardless of starting blood pressure.

As systolic blood pressure fell, the risk of renal events also dropped. This was apparent even with a pressure below 110 mmHg.

Still, whether the effects on albuminuria translate into more long-term clinical benefits is unknown. "Most of the findings related to early manifestations of kidney disease and the study was not large enough to assess the impact of the intervention directly on the risk of kidney failure," Dr. Perkovic said in a statement.

Also, he added, "We could not separate out the impact of the blood pressure-lowering combination used, or prove whether it had any effects beyond its blood pressure-lowering effects."

J Am Soc Nephrol 2009.